<fieldset>
	<legend>Account Details</legend>
	
	<%= error_messages_for :customer %>
	<!-- Identification is based on customer email address -->
	
<% form_for(@customer) do |f| %>

  <p>
    <b>Phone Number</b><br />
      <%= f.text_field :phone_number %><br/>
    <cite>Eg: 9196014554</cite>
  </p>
 
	<b>Membership Plan</b><br />
  <p>
 	<%= f.radio_button(:interval, "1") %> Monthly <br>
 	<%= f.radio_button(:interval, "12") %> Annual
  </p>

</fieldset>

<fieldset>
	<legend>Credit Card Details</legend>
	Please enter the name as it appears on the credit card
	 <p>
	   <b>First Name</b><br />
	   <%= text_field_tag :first_name, "", :size => 30  %><br/>
	 </p>
	 <p>
	   <b>Last Name</b><br />
	   <%= text_field_tag :last_name, "", :size => 30 %><br/>
	 </p>
	 <p>
	   <b>Credit Card Number</b><br />
	   <%= text_field_tag :credit_card_number, "", :size => 30 %>
	 </p>
	 <cite>Eg. 4011786843211467</cite>
	<p> 
	   <label for="expiration_date"><strong>Expiration Date</strong></label> 
	   <%= select_tag :month, expiration_month, :style => "width: 50px" %>
	   <%= select_tag :year, expiration_year, :style => "width: 70px" %> 
	   <br>
	</p>
	
 </fieldset>

<fieldset>
  <legend>Billing Address</legend>
  
   <p>
     <b>Address</b><br />
     <%= text_field_tag :billing_address, "", :size => 30  %>
   </p>
   <p>
     <b>City</b><br />
     <%= text_field_tag :billing_city, "", :size => 30  %>
   </p>
   <p>
     <b>State</b><br />
     <%= text_field_tag :billing_state, "", :size => 30  %>
   </p>
   <p>
     <b>Zip</b><br />
     <%= text_field_tag :billing_zip,"",  :size => 10  %>
   </p>
 
</fieldset>


<fieldset>
	<legend>Mailing Address</legend>
	<input name="chkCopy" type="checkbox" value="" onClick="copyAddress();">
	<label>Same as billing address</label>

	 <p>
	   <b>Address</b><br />
	   <%= text_field_tag :shipping_address, "", :size => 30  %>
	 </p>
	 <p>
	   <b>City</b><br />
	   <%= text_field_tag :shipping_city, "", :size => 30  %>
	 </p>
	 <p>
	   <b>State</b><br />
	   <%= text_field_tag :shipping_state, "", :size => 30  %>
	 </p>
	 <p>
	   <b>Zip</b><br />
	   <%= text_field_tag :shipping_zip,"", :size => 10  %>
	 </p>

</fieldset>


  <p>
    <%= f.submit "Create" %>
  </p>
<% end %>